Nokea
The nurse is caring for a patient with vomiting of 'coffee-ground' emesis. Which of the following procedures should the nurse anticipate for the patient?
- A. Endoscopy
- B. Angiography
- C. Gastric analysis testing
- D. Barium contrast studies
Correct Answer: A
Rationale: Endoscopy is the primary tool for visualization and diagnosis of upper gastrointestinal (GI) bleeding. Angiography is used only when endoscopy cannot be done because it is more invasive and has more possible complications. Gastric analysis testing may help with determining the cause of gastric irritation, but it is not used for acute GI bleeding. Barium studies are helpful in determining the presence of gastric lesions, but not whether the lesions are actively bleeding.
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The nurse is caring for a patient with deep partial-thickness burns who is anxious about the upcoming dressing change, is in severe pain, and is nauseated. Which of the following actions will be most useful in decreasing the patient's nausea?
- A. Keep the patient NPO for 2 hours before and after dressing changes.
- B. Avoid performing dressing changes close to the patient's mealtimes.
- C. Administer the prescribed morphine sulphate before dressing changes.
- D. Give the ordered prochlorperazine before dressing changes.
Correct Answer: C
Rationale: The patient's nausea is associated with stress and severe pain, therefore the best treatment will be to provide adequate pain medication before dressing changes. The nurse should avoid doing painful procedures close to mealtimes, but nausea or vomiting that occurs at other times also should be addressed. Keeping the patient NPO does not address the reason for the nausea and vomiting and will have an adverse effect on the patient's nutrition. Administration of antiemetics is not the best choice for a patient with nausea caused by pain.
The nurse is caring for a patient with a peptic ulcer and a nasogastric (NG) tube who develops sudden, severe upper abdominal pain, diaphoresis, and a firm, rigid abdomen. Which of the following actions should the nurse take next?
- A. Irrigate the NG tube.
- B. Obtain the vital signs.
- C. Listen for bowel sounds.
- D. Give the ordered antacid.
Correct Answer: B
Rationale: The patient's symptoms suggest acute perforation, and the nurse should assess for signs of hypovolemic shock. Irrigation of the NG tube, administration of antacids, or both would be contraindicated because any material in the stomach will increase the spillage into the peritoneal cavity. The nurse should assess the bowel sounds, but this is not the first action that should be taken.
The health care provider prescribes the following therapies for a patient who has been admitted with dehydration and hypotension after 3 days of nausea and vomiting. Which order should the nurse implement first?
- A. Infuse normal saline at 250 ml/hour.
- B. Administer IV ondansetron.
- C. Provide oral care with moistened swabs.
- D. Insert a nasogastric (NG) tube.
Correct Answer: A
Rationale: Because the patient has severe dehydration, rehydration with IV fluids is the priority. The other orders should be accomplished as quickly as possible after the IV fluids are initiated.
All of the following prescriptions are received for a patient who has vomited 1500 mL of bright red blood. Which order will the nurse implement first?
- A. Insert a nasogastric (NG) tube and connect to suction.
- B. Administer intravenous (IV) famotidine
- C. Draw blood for type and crossmatch.
- D. Infuse 1000 mL of lactated Ringer's solution.
Correct Answer: D
Rationale: Because the patient has vomited a large amount of blood, correction of hypovolemia and prevention of hypovolemic shock are the priorities. The other actions also are important to implement quickly but are not the highest priorities.
A patient recovering from a gastrojejunostomy (Billroth II) for treatment of a duodenal ulcer develops dizziness, weakness, and palpitations about 20 minutes after eating. Which of the following information should the nurse teach to the patient to avoid recurrence of these symptoms?
- A. Lie down for about 30 minutes after eating.
- B. Choose foods that are high in carbohydrates.
- C. Increase the amount of fluid intake with meals.
- D. Drink sugared fluids or eat candy after each meal.
Correct Answer: A
Rationale: The patient is experiencing symptoms of dumping syndrome, which may be reduced by lying down after eating. Increasing fluid intake and choosing high carbohydrate foods will increase the risk for dumping syndrome. Having a sweet drink or hard candy will correct the hypoglycemia that is associated with dumping syndrome but will not prevent dumping syndrome.